Yamamoto K.,University of Tokyo |
Goto H.,Fukujuji Hospital |
Hirao K.,Tokyo Medical and Dental University |
Nakajima A.,Tokyo Metropolitan Police Hospital |
And 4 more authors.
Journal of Rheumatology | Year: 2015
Objective. To evaluate the longterm safety of tocilizumab (TCZ) for the treatment of rheumatoid arthritis (RA) in a real-world clinical setting in Japan. Methods. In this longterm extension of a single-arm, observational postmarketing surveillance study, a total of 5573 patients who initiated intravenous TCZ between April 2008 and July 2009 were observed for 3 years, regardless of its continuation, for incidence of fatal events, serious infections, malignancy, gastrointestinal perforations, and serious cardiac dysfunction. Results. Of the 5573 patients who were enrolled, 4527 patients (81.23%) completed 3 years of followup. There were no increases in the proportions of patients with fatal events, serious infection, malignancy, GI perforation, or serious cardiac dysfunction over 3 years. The all-cause mortality rate during followup was 2.58% (0.95/100 patient-yrs), and the standardized mortality ratio was 1.27 (95% CI, 1.08 to 1.50). Patients who were older with longer disease duration and respiratory comorbidities were more likely to discontinue TCZ treatment following serious infection during the first year. Among patients who completed 3 years of TCZ treatment, serious infection developed at a constant rate during the 3-year treatment period. The proportion of malignancy during followup was 2.24% (0.83/100 patient-yrs), and the standardized incidence ratio was 0.79 (95% CI, 0.66 to 0.95). Conclusion. The safety profile of TCZ was consistent over time regarding mortality, serious infections, malignancy, gastrointestinal perforation, and serious cardiac dysfunction. These data confirm the longterm safety of TCZ use in patients with RA in a real-world clinical setting. © 2015 The Journal of Rheumatology. All rights reserved.
Takenouchi M.,Juntendo University |
Takenouchi M.,Tokyo Metropolitan Police Hospital |
Hirai S.,Sapporo Medical University |
Sakuragi N.,Sapporo Medical University |
And 4 more authors.
Clinical Cancer Research | Year: 2011
Purpose: The interleukin-13 receptor a2 (IL-13Ra2) is expressed by a variety of human malignant cells. Here, we have examined the constitutive surface expression and the epigenetic regulation of IL-13Ra2 by human mesothelioma. We have also investigated the therapeutic effect of the DNA methylation inhibitor 5-aza-20-deoxycytidine (5-aza-dC) and anti-IL-13Ra2 monoclonal antibody on mesothelioma xenografts. Experimental Design: Cell surface expression of IL-13Ra2 by various lung carcinomas was analyzed using flow cytometry. Therapeutic effects of anti-IL-13Ra2 and 5-aza-dC were investigated using antibodydependent cellular cytotoxicity and proliferation assays and by monitoring the survival of mesotheliomabearing mice. Results: We found that human malignant mesotheliomas expressed surface IL-13Ra2 on their surface and that it was upregulated by treatment with 5-aza-dC. This augmented expression of IL-13Ra2 resulted in growth inhibition of the mesothelioma cells when cocultured with anti-IL-13Ra2 and effector cells, such as splenocytes and peritoneal exudate cells. The growth inhibition of mesothelioma cells was mediated by IFN-g that was only detected in the supernatant when effector cells were exposed to 5-aza-dC-treated tumors in the presence of anti-IL-13Ra2. Compared with the control or either regimen alone, in vivo administration of anti-IL-13Ra2 in combination with 5-aza-dC significantly prolonged the survival of mice with mesothelioma xenografts. Conclusions: These observations indicate a promising role for IL-13Ra2 as a target for antibody treatment in malignant mesothelioma, and, in combination with epigenetic regulation by a DNA methylation inhibitor, suggest the potential for a novel strategy to enhance therapeutic potency. ©2011 AACR.
Shibata E.,Tokyo Metropolitan Police Hospital |
Shibata E.,University of Tokyo |
Ueda T.,St Lukes International Hospital |
Akaike G.,St Lukes International Hospital |
Saida Y.,St Lukes International Hospital
Abdominal Imaging | Year: 2014
Purpose: To illustrate the CT findings of gastrointestinal anisakiasis. Subjects and methods: The Institutional Review Board approving this retrospective study waived the requirement for informed consent. Review of our emergency department's clinical records from September 2008 to January 2012 identified 41 consecutive patients who were diagnosed with gastrointestinal anisakiasis. 20 patients were diagnosed with gastric anisakiasis with endoscopically proven Anisakis larvae, and 21 patients were diagnosed with intestinal anisakiasis with positive test results for anti-anisakidae antibody and the presence of intestinal lesions on CT. Two radiologists retrospectively assessed the CT findings. Results: The mean time delay from raw fish ingestion to symptom onset was 5.2 h (range 0.5-24 h) in gastric anisakiasis and 39 h (range 12-120 h) in intestinal anisakiasis. Gastric anisakiasis showed marked submucosal edema of the gastric wall (20/20 patients, 100%), increased attenuation of adjacent fat (19/20, 95%), and ascites (14/20, 70%) on CT. Intestinal anisakiasis showed marked submucosal edema of the intestine (21/21 patients, 100%) without showing complete intraluminal occlusion, ascites (21/21, 100%), increased attenuation of adjacent fat (19/21, 90%), and fluid collection in the distal segment of the constricted small intestine (13/21, 62% ) on CT. Conclusion: Severe submucosal edema with ascites is a characteristic finding of gastrointestinal anisakiasis when compared with other forms of gastroenteritis. When CT shows the typical findings of gastrointestinal anisakiasis, radiologists may suggest the possibility of clinically undiagnosed anisakiasis, especially in intestinal anisakiasis as the diagnosis is sometimes difficult due to the long interval between food intake and symptom onset. © The Author(s) 2014.
Tsuzaka Y.,Tokyo Metropolitan Police Hospital |
Matsushima H.,Tokyo Metropolitan Police Hospital |
Kaneko T.,Tokyo Metropolitan Police Hospital |
Yamaguchi T.,Tokyo Metropolitan Police Hospital |
Homma Y.,University of Tokyo
International Journal of Urology | Year: 2011
The aim of the present study was to compare the efficacy of the selective α 1D-adrenoceptor antagonist naftopidil and the selective α 1A-adrenoceptor antagonist silodosin (as an example) in the management of ureteral stones in Japanese male patients. A total of 74 patients with symptomatic ≤10mm ureteral stones were enrolled in a prospective study and randomized into two groups: Group 1 received 50mg naftopidil daily, whereas Group 2 received 8mg silodosin daily. Patients were followed-up for up to 6weeks. The primary endpoint was stone expulsion rate and secondary endpoints were stone expulsion time, the rate of interventions, such as transurethral ureterolithotripsy, extracorporeal shock wave lithotripsy, or ureteral stenting, and side effects. There were no significant differences between the two groups with respect to age, stone size, and location. The stone expulsion rate was 61% and 84% in the naftopidil and silodosin groups, respectively (P=0.038). No significant differences were noted in stone expulsion time or the rate of interventions between the two groups. The findings suggest that α 1A-adrenoceptor blockade was clinically superior for stone expulsion our study population. © 2011 The Japanese Urological Association.
Sakata R.,University of Tokyo |
Sakata R.,Tokyo Metropolitan Geriatric Hospital |
Aihara M.,University of Tokyo |
Murata H.,University of Tokyo |
And 4 more authors.
Investigative Ophthalmology and Visual Science | Year: 2013
PURPOSE. We investigated the correlation between 24-hour IOP in the habitual (sitting during day and supine during night) position (H24h-IOP) and IOP after a postural-change test (PCTIOP) and a water-drinking test (WDT-IOP). We also investigated ocular and systemic factors related with them in patients with normal tension glaucoma (NTG). METHODS. Japanese NTG patients underwent H24h-IOP, PCT-IOP, and WDT-IOP measurements during a 24-hour period. Correlations among H24h-IOP, PCT-IOP, and WDT-IOP, and contributing ocular/systemic factors were investigated using regression analysis. RESULTS. There were 33 patients included. Peak H24h-IOP correlated positively with peak PCT IOP and peak WDT-IOP (estimate = 0.422 and 0.419, P ≤ 0.010), and peak PCT-IOP with WDT-IOP (0.44, P = 0.002). Peak H24h-IOP correlated with refraction (0.36, P = 0.048) and negatively with the mean deviation (MD, -0.066, P = 0.031). MD and baseline IOP (the mean of H24h-IOP) correlated negatively with the H24h-IOP fluctuation (-0.058 and -0.58, P ≤ 0.050). Refraction, baseline IOP, mean blood pressure (mBP), and body mass index (BMI) correlated with peak PCT-IOP (0.23, 0.52, 0.097, and 0.32, respectively, P ≤ 0.038). PCT-IOP difference correlated with refraction and mBP (0.31 and 0.093, P ≤ 0.016) and negatively with age (-0.069, P = 0.003). Central corneal thickness, baseline IOP, age, and BMI correlated with peak WDT-IOP (0.030, 0.40, 0.088, and 0.26, P ≤ 0.050). Age and BMI correlated with WDT-IOP difference (0.086 and 0.20, P < 0.032). CONCLUSIONS. Positive correlation was found among the peaks of H24h-, PCT-, and WDT-IOP. A worse visual field was associated with higher peak and greater fluctuation of H24h-IOP in NTG. Several ocular/systemic factors were important in interpreting H24h-, PCT-, and WDTIOP. © 2013 The Association for Research in Vision and Ophthalmology, Inc.
Haraguchi N.,Tokyo Metropolitan Police Hospital |
Ota K.,Tokyo Metropolitan Police Hospital |
Tsunoda N.,Tokyo Metropolitan Police Hospital |
Seike K.,Tokyo Metropolitan Police Hospital |
And 2 more authors.
Journal of Bone and Joint Surgery - American Volume | Year: 2015
Background: We determined the preoperative and postoperative passing points of the mechanical axis of the lower limb at the level of the tibial plafond using a new method involving a full-length standing posteroanterior radiograph that includes the calcaneus (a hip-to-calcaneus radiograph) and correlated them to the clinical results after supramalleolar osteotomy for ankle osteoarthritis. Methods: We reviewed the hip-to-calcaneus radiographs of fifty lower limbs of forty-one patients treated for lower limb malalignment at our institution. The mechanical axis point of the ankle was the point at which the mechanical axis divides the coronal length of the plafond, expressed as a percentage. Four independent observers performed all measurements twice. Supramalleolar tibial osteotomy was performed in twenty-seven ankles (twenty-four patients) to treat moderate varus-type osteoarthritis of the ankle. The mean follow-up period was 2.8 years (range, two to 5.3 years). Clinical assessment was based on the American Orthopaedic Foot & Ankle Society (AOFAS) scale. Results: Interobserver and intraobserver reliability in identifying the mechanical ankle joint axis point were very high. The mean postoperativemechanical axis point was 50% (range, 13% to 70%) in ankles for which the preoperative point was ≤0%, whereas the mean postoperative point was 81% (range, 48% to 113%) in ankles for which the preoperative point was >0%. The mean change in AOFAS score was significantly less for patients with a preoperative point of ≤0% than for those with a preoperative point of >0% (p = 0.004). Improvement was significantly greater in ankles with a postoperative mechanical ankle joint axis point of ≥80% than in ankles with a postoperative mechanical ankle joint axis point of <60% (p = 0.030). Conclusions: Traditional tibial correction resulted in great variation in the locations of the postoperative mechanical ankle joint axis point. In ankles with the preoperative point more medial than the tibial plafond, the point was insufficiently moved to the lateral side, and the clinical outcomes were less satisfactory. Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated.
Kohno M.,Tokyo Metropolitan Police Hospital |
Sato H.,Tokyo Metropolitan Police Hospital |
Sora S.,Tokyo Metropolitan Police Hospital |
Miwa H.,Tokyo Metropolitan Police Hospital |
Yokoyama M.,Tokyo Metropolitan Police Hospital
Neurosurgery | Year: 2011
BACKGROUND: There are arguments about whether acoustic neuromas are epiarachnoid or subarachnoid tumors. OBJECTIVE: To retrospectively examine 118 consecutively operated-on patients with acoustic neuromas to clarify this point. METHODS: Epiarachnoid tumors are defined by the absence of an arachnoid membrane on the tumor surface after moving the arachnoid fold (double layers of the arachnoid membrane) toward the brainstem. In contrast, subarachnoid tumors are characterized by the arachnoid membrane remaining on the tumor surface after moving the arachnoid fold. Based on this hypothesis, we used intraoperative views and light and electron microscopy to confirm the existence of an arachnoid membrane after the arachnoid fold had been moved. RESULTS: The tumors were clearly judged to be subarachnoid tumors in 86 of 118 patients (73%), an epiarachnoid tumor in 2 patients (2%), whereas a clear judgment was difficult to make in the remaining 30 patients (25%). CONCLUSION: The majority of acoustic neuromas are subarachnoid tumors, with epiarachnoid tumors being considerably less common. © 2011 by the Congress of Neurological Surgeons.
Kohno M.,Tokyo Metropolitan Police Hospital
Japanese Journal of Neurosurgery | Year: 2012
The anterior transpetrosal approach is a skull base approach that is used for treating lesions in the cerebellopontine angle or pre-pontine area. Trigeminal schwannomas and tentorial meningiomas extending to the Meckel’s cave are good indications for this surgical approach. This approach is also applicable for basilar trunk aneurysms and pontine cavernomas or gliomas. The weak points of this approach are a narrow and deep operative field, the necessity of temporal lobe retraction, and a limited lesion site for manipulation this surgical approach is not appropriate for lesions located around the lower cranial nerves. . Complications such as temporal lobe problems are concerns for surgeons during this procedure therefore, lumbar drainage and or controlling brain retractors are recommended for preventing these difficulties. Given that performance of the anterior transpetrosal approach requires skillful skull base techniques and mastery of methods to prevent complications, this surgical approach is not considered easy. Therefore, surgeons who perform this approach must have adequate knowledge of surgical anatomy so as not to be disoriented during surgerythey must also be aware of potential complications and how to avoid them. © 2012, Japanese Congress of Neurological Surgeons. All rights reserved.
Hagiwara A.,Tokyo Metropolitan Police Hospital
Japanese Journal of Clinical Radiology | Year: 2015
The case is a 39 year old male who presented with discomfort in epigastric area to a primary care physician. A retroperitoneal tumor with arborizing calcification was found incidentally on an abdominal CT. He underwent a surgery with preoperative diagnosis of hyaline vascular type Castleman's disease and it was confirmed pathologically. The presence of arborizing calcification can be helpful to the correct diagnosis of hyaline vascular type Castleman's disease. We report this case with review of literatures.
Ebisawa T.,Tokyo Metropolitan Police Hospital
Molecular Genetics and Genomics | Year: 2013
Genetic studies have revealed several clock gene variations/mutations involved in the manifestation of sleep disorders or interindividual differences in sleep-wake patterns, but only part of the genetic risk can be explained by the gene variations/mutations identified to date. Recent progress in research into circadian rhythm generation has provided efficient tools for eliciting the molecular basis of clock-relevant sleep disorders, complementing traditional genetic analysis. While the human master clock resides in the suprachiasmatic nucleus of the hypothalamus (central clock), peripheral tissue cells also generate self-sustained circadian oscillations of clock gene expression (peripheral clock), enabling estimation of individual human clock properties through a single collection of skin fibroblasts or venous blood cells. Some of the established cell lines exhibit autonomous circadian oscillations of clock gene expression, and introduction of clock gene variations into these cell lines by gene targeting makes it possible to investigate changes in the circadian phenotype induced by these variations/mutations without the need for generating transgenic animals. Estimation of human clock properties using peripheral tissue cells, in addition to genetic analysis, will facilitate comprehensive explication of the genetic risk of a variety of disorders relevant to biological clock disturbances, including sleep disorders, mood disorders, and metabolic diseases. © 2013 Springer-Verlag Berlin Heidelberg.